Keynote Lecture slides - Minority Health Project

32nd Annual Minority Health Conference
UNC Gillings School of Global Public Health
University of North Carolina, Chapel Hill
William T. Small Jr. Keynote Lecture, 2/25/11
Bonnie Duran DrPH
Director, Center for Indigenous Health Research
Indigenous Wellness Research Institute www.iwri.org
Associate Professor, Department of Health Services
School of Public Health, University of Washington
Madame Chair and the
MyNavajo
Context
Nation HRRB
4CC Project
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Has western knowledge production itself contributed to
health inequities?
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Is there a power/knowledge episteme of public health
that replicates colonial relationships?
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Can Indigenous communities, other communities of color,
public health advocates and allies use partnership
opportunities and research spaces for indigenous
knowledge development?
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New western scholarship about pre-colonized
America’s
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Define Modernity/Coloniality Episteme
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Examples of colonizing research
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Decolonizing research and practice: CBPR
and the space for indigenous knowledge
development
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In 1491 there were more
people living in the Americas
than in Europe.

Indigenous people in the
America’s transformed their
land so completely that
Europeans arrived in a
hemisphere already
massively "landscaped" by
human beings.

Pre-Columbian Indians in
Mexico developed corn by
a breeding process so
sophisticated that a
“Science” author
described it as "man’s
first, and perhaps the
greatest, feat of genetic
engineering."
AGRICULTURE Prehistoric GM Corn Nina V. FedoroffS Science
14 November 2003: 302 (5648), 1158-1159.
[DOI:10.1126/science.1092042]
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Tenochtitlan, the Aztec
capital had a far greater
in population than any
contemporary European
city, and unlike any
capital in Europe at that
time, had running water,
beautiful botanical
gardens, and
immaculately clean
streets.
Alfred W. Crosby, author of Ecological Imperialism and The Columbian Exchange, Professor Emeritus of
Geography, American Studies and History, University of Texas
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Genealogy: 17th Century No. Europe Reformation thought,
Enlightenment, French Revolution crystallized in 18th Century
into “Modernity/Coloniality” and consolidated within the
Industrial Revolution and motivated, in part, by colonization

Philosophically, emergence of the notion of “Man” as the
foundation for all knowledge & order, separate from the
natural and the divine
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Culturally, Lifeworld is subsumed by forms of expert
knowledge linked to capital and state administrative
apparatuses (Foucault's disciplines)
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Sociologically, rise of nation-state institution, knowledges for
material reproduction Indigenous and Subalterns studies scholars in the America’s,
India, the Atlantic, Poststructuralists, Critical theorists..
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Western knowledge contains a worldview that sees human
development in terms of a master narrative requiring the
congruence of other cultures.

Authority to determine fitness for world citizenship is based on
Western knowledge that decides the criteria for what is
reasonable and what is not reasonable.

Globalization: all world cultures and societies are reduced to being
a manifestation of European history and culture.

Modern reason is emancipatory, but modernity’s “underside,”
namely, the imputation of the superiority of European civilization,
coupled with the assumption that Europe’s development must be
followed unilaterally by every other culture
ColonialityModernity
• Starts in Greece and
Rome
• Rooted in rhetoric of
salvation and
progress
• By necessity creates
condemnatory logic,
savage, primitive,
marginalized
Post-Coloniality
Indigenous Episteme
• Starts in Greece and Rome
• Privileges “newness” in
the
archaeology/chronological
history of european ideals
• Subjectivities created in
language and history
• Starts with a critique of the
limits of Eurocentric
knowledge hegemony of
“science” as truth:
Provincialism as Universalism
• Epistemic disobedience as a
set of projects that focus on
the common effects of the
experience of colonialism
• Shifts the geographies of
reason
• Language and concepts as
only one vehicle to
understand and express
“reality”
* From at least a “post” perspective

..defines episteme historically as the strategic
apparatus which authorizes
 separating out from among all the statements which
are possible
 those that will be acceptable in a field of scientificity,
and
 which it is possible to say are true or false or
“meaningless” *
Michel Foucault, Power/Knowledge (1980, p.197)
*My addition - borrowed from Sami Scholar Rauna Kuokkanen
Colonial Research Practice:
Examples of Knowledge/Power
Nexus
Indigenist Critique of Western
Episteme’s
History is written
by people in power
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Colonization -

Governance of “frontier”
by ‘central’ authority

Main governance
institutions:
 Geographical incursion
 Ideological “stories” about
race & skin color
 Church
 Socio-cultural dislocation
 Medicine/Public Health
 Education/Research
 External political control
 Provision of low-level social
services
 Business/Industry

Both similar and different from
larger global imperial projects
Kelm, M.-E. (1998). Colonizing bodies : aboriginal health and healing in
British Columbia, 1900-50. Vancouver, BC: UBC Press.

Assimilation and Allotment 1870-s - early 1900s
 1880’s Growth of BIA boarding schools
 1883 Some Traditional Medicine Outlawed
 1887 Allotment Act abolishes group title to Native land
Shelton, B. L. (2004). Legal and Historical Roots of Health Care
for American Indian and Alaska Native in the United States. Menlo
Park & Washington DC: The Henry J. Kaiser Family
Foundation.
“Promiscuous sexual intercourse
among the unmarried of the
Apache Indians is common.
They are polygamist. The
women are unclean and
debased. The Navajos’ , a
branch of the Apache tribe,
line in the rudest huts and
lead a drunken worthless life.
The women are debased and
prostituted to the vilest
purposes. Syphilitic diseases
abound….”
McClellan, E. (1873). Obstetric
Procedures among the
Aborigines of North America.
Clinic of the Month, 99-106.
 “it seems ..a reproach
upon Him...that she
should be the most
poorly prepared ..for
the reproduction of her
kind…”
Parker, T. (1891). Concerning American
Indian Womanhood-An Ethnological Study.
American Gynecology and Pediatrics, 5, 330-341.
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The basket drum
The drum stick
The Plumed wands
Kethawns
Sacrificial
Cigarettes
Matthews, W. (1893). Some
Sacred Objects of the Navajo
Tribe. Archives of the International
Folklore Association 1, 227-254.

…the greatest, most
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“…determine question of
whether true Indian is
dying out’.
precise, productive, and
comprehensive system of
control of human beings
will be built on the
smallest and most
precise of bases.
Hoffman, F. (1928). The Navajo Population
Problem. Proceedings of the twenty-third
International Congress of Americanists 23, 620-633.
Hoffman, F. (1930). Are the Indians Dying Out?
American Journal of Public Health, 20, 609-614.

Knowledge, race and social position
 Interpreter, health educator, health systems navigator, medicine person…
• …driver
Nursing outlook,
June 1961

Health research served
as a “roadmap” for
colonizers who utilized
IHS to overcome
difficulties of
transportation and
communication in more
remote, previously
inaccessible locations
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DR is a purposeful approach
to “transforming the
institution of research, the
deep underlying structures
and taken-for-granted ways
of organizing, conducting,
and disseminating research
knowledge”

DR enables indigenous
communities to theorize their
own lives connecting with
past and future generations
Drawn from work of Smith, L.T. (2005). On Tricky Ground: Researching in the Age of Uncertainty. In Denzin &
Lincoln (eds.). Handbook of Qualitative Research. Sage Publications

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Indigenous knowledge (IK) as ancient,
communal, holistic, spiritual and systematic
knowledge about every aspect of human
existence
Local communities through accumulated IK
gained from generation to generation, knew:
 Social order through culture-based sanctions and rewards
for appropriate behavior
 Longevity through Indigenous Public Health
 Healthy physical environments through stewardship, ETC
ETC ETC

“Logic of the gift” as a foundational epistemic
convention grounded in valuing

Gifting functions as a system of social relations,
forming alliances, solidarity

Gifting extends to giving and receiving in the
natural and spiritual realms

Reconstructing indigenous Epistemes offers
alternative paradigm for everyone, not just
Natives..
Rauna Kuokkanen (2007) Reshaping the University: Responsibility, Indigenous
Epistemes, and the Logic of the Gift. Vancouver, University of British Columbia Press
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Evidence based
Interventions may be a
form of forced
acculturation

Indigenous health
promotion and
treatment is often
effective “cultural
revitalization”
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 cumulative
vulnerability that
colonization; i.e.,
epidemic disease,
forced removal,
warfare, and white
cultural hegemony,
have had on the
physical
manifestation of
health among
indigenous peoples.
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Story telling
Sweat Lodge
Talking circle
Vision quest
Wiping of tears
Drumming
Smudging
Traditional Healers
Herbal remedies
Traditional activities
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Decolonizing research
and training

Partnerships with T/U/I

Indigenous Knowledge
reclamation and
production

Harness resources of UW
and partners towards
mission

Partners – MOU with
 American Indian Higher
Education Consortium
 Northwest Indian College
 National Congress of
American Indian Policy
Research Center
 National Indian Health
Board
 Affiliated Tribes of
Northwest Indians
Center for
Indigenous Health
Research -- IWRI
Navajo Nation
NM Pueblo’s
AAIHB
NRG UW
NWIC
AIHEC
30 TCU
Genealogy of Partnerships
Funding NIDA, OBSSR, NCRR, IHS
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UNM TEAM
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UNM & UW TEAM
The NCAI Policy Research Center is a tribally-driven think tank that supports
Native communities in shaping their own future by gathering credible data,
building tribal research capacity, providing research support, and convening
forums addressing critical policy questions.
As sovereign nations, tribes have a role in the research that is conducted in their
communities and in regulating research which occurs on their land and with their
citizens.
- Joe Garcia,
Former President, NCAI
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Established in 2003 as a national tribal policy
research center that would focus solely on
issues facing tribal communities

Forum for forward-thinking, deliberate,
proactive Indian policy discussions and the
development of policy scenarios
Research in service to community
Direct implications for communities and improving their
well-being
Community-driven agenda and all aspects of the work
Honor community and cultural contributions to the work
Partnership with communities and other organizations
Respect tribal sovereignty and ownership of data
Indigenous knowledge is as valid as academic knowledge
Research should build community capacity
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Partnership between Indian Health Service &
NIH
3 Goals Reduce mistrust
 train “Expert Indians”, pipeline program
 conduct rigorous health disparities research

Tribal organization must be lead and
maintain 30% of funds
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1. Describe the variability of CBPR across
dimensions in the model to identify
differences and commonalities across
partnerships

2. Describe and assess the impact of
governance on CBPR processes and
outcomes across AI/AN and other
communities of color.
3. Examine the associations among group dynamic
processes and three major CBPR outcomes:
 culturally-responsive and centered interventions;
 strengthened research infrastructure and other
community capacities; and
 new health-enhancing policies and practices, under
varying conditions and contexts.
4. Identify and disseminate best and promising
practices, assessment tools, and future research
needs
MODELS ARE “AN IDEALIZED
REPRESENTATION OF REALITY THAT
HIGHLIGHTS SOME ASPECTS AND IGNORES
OTHERS.”*
* Pearl, J. (2000). Causality: Models, reasoning, and inference.
Cambridge, England: Cambridge University Press.
“MODELS OF COURSE ARE NEVER
TRUE, BUT FORTUNATELY IT IS ONLY
NECESSARY THAT
THEY BE USEFUL”**
** Box, G. E. P. (1979). Some problems of statistics and everyday
life. Journal of the American Statistical Association, 74, 1–4
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369+ Federally funded
active in 2010
Vulnerable population
 Include NARCH
 n = 126
Children/Youth
 Include PRC
 n = 61
Low-Income
 n = 14
People w/ Disability
 n = 27
Elderly
 API 15
 n = 53
Rural
 AA 72
 n = 45
Migrant / Immigrant
 Latino 97
 n = 56
Families
 N= 427
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Ethnicity
 AIAN 32
 White 7
 Multicultural 48
 n=3
LGBTQ / MSM
 None of the above 107
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NIDA 5R01DA029001-02
Funding period: 2009 – 2013
Partner: American Indian Higher Education Consortium- 31 Tribal Colleges and Universities
Leo Egashira
Maya Magarati
Myra Parker
Ramona Beltran
Elana Mainer
1.
Establish partnership and board (CBPR)
2.
Compile and summarize literature
3.
Key Stakeholders survey-needs and
capacity
4.
Qualitative review of culture-centered and
evidence based interventions
5.
Develop effective outreach and screening
procedures
In the Practice World
Adapted from:
The California Endowment
Rodney Hopson, Ph.D.
1.
The social location of the student/researcher
matters (intersectionality)
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Gender
Race
Class
Ethnicity
Education
Privilege/target
Sexual orientation
Etc… What else?
Hankivsky, O., & Cormier, R. (2009). Intersectionality: Moving Women’s Health Research and
Policy Forward. Vancouver: Women’s Health Research Network.
This publication is also available online at www.whrn.ca.
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2. Research plays a role in furthering social change
and social justice
 Ability and duty to recognize asymmetric power relations
and to
 challenge systems and mechanisms of inequity and
injustice
 in hope of dismantling oppression
Theoretical approaches: Indigenist, Queer, critical,
feminist, cultural humility, anti-racist, postcolonial,
etc… What else?
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3. Avoiding ethnocentrism means embracing
multiple cultural perspectives
 shift between diverse perspectives
 Recognizes ethnocentric standards and ideas

HOW?
 Employ a team who can “translate” research from
multiple cultural contexts
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4
Culture is central to the research process
 worldview, values and norms impact the uses of,
reactions to, and legitimacy of, any research
 multicultural validity - defining social problems
 norms will play out in the context of research
instruments and protocols.
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5
Culturally and ethnically diverse
communities have contributions to make
in redefining the research field
 standards, guidelines, methods and paradigms of
the research field need to be rethought, and
underserved and marginalized culturally diverse
groups have an important role to play in this
process
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The role of the intellectual, according to
Delueze, is not to awake consciousness but to
weaken the power of hegemonic discourse
and to create the space for competing
discourses to be formulated and dispersed.
From this position, then…if you make it your task
not only to learn what’s going on there through
language, through specific programs of
study…through historical critique of your position
as the investigating person. When you take the
position of not doing your homework, I will not
criticize because of the accident of my birth, the
historical accident, that is a pernicious position.
Gayatri Spivak.
Postcolonial critic
Quote from Navajo Nation IRB Chair, Ms. Beverly Pigman (June 27, 2006)
May all beings be happy.
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